Long-term neurodevelopmental outcome of triplets SKRABLIN, Snjezana; KUVACIC, Ivan; SIMUNIC, Velimir ...
European journal of obstetrics & gynecology and reproductive biology,
05/2007, Letnik:
132, Številka:
1
Journal Article
Recenzirano
Abstract Objective To analyze the incidence of neurodevelopmental disabilities in triplets and to find out possible connection between the outcome and perinatal events. Design Retrospective cohort ...study of 94 triplets and their outcome at 24–144 months of age correlated with gestational age, birth weight, pregnancy complications, early neonatal period, neonatal cranial ultrasound, period of birth (1985–1995, 1996–2000) and type of antenatal care. Results Sixty-two triplets are healthy, 15 suffer cerebral palsy (CP) and 17 minimal cerebral dysfunction (MCD). Adverse outcome correlates significantly with prematurity, low birth weight and maternal age. In multivariate analysis, both cerebral palsy and minor disabilities correlate significantly with early neonatal complications, neonatal cranial ultrasound with later CP ( p < 0.01), and MCD with preterm rupture of membranes ( p = 0.047). Children conceived spontaneously do worse than those born after assisted reproduction ( p = 0.004), those born in the time period 1996–2000 do better than those born before ( p = 0.021). Seventy-seven percent (77%) of newborns delivered in the time period 1996–2000 and after level 1 antenatal care was introduced, compared with 54% being delivered in the time period before 1996 and with less meticulous types of antenatal care, remain healthy ( p = 0.015). Conclusion Triplets are still at high risk for long-term neurodevelopmental complications. Stringent perinatal care might appear important determinant of their long-term outcome.
BASE: There are numerous studies that indicate the co-morbidity of a metabolic syndrome and mental disorders. Metabolic syndrome and mental disorders in pregnant women are rarely investigated, ...especially in pathological pregnancy.
To determine a relationship between predisposed factors in pregnancy and the occurrence of metabolic syndrome as well as to determine the occurrence of psychological symptoms and disorders in pregnant women.
The tested sample consisted of 162 pregnant women (80 with normal and 82 with pathological pregnancy). For the examination, 3 questionnaires were used: clinical, laboratory, ultrasound and radiological scanning. Metabolic syndrome was diagnosed according to WHO criteria, and psychological symptoms by using the SCL 90-R questionnaire.
Metabolic syndrome was confirmed in 19 (23.2%) women with pathological pregnancy. These women had a greater prevalence of psychological symptoms (p<0.001).
Women with pathological pregnancy who are diagnosed with metabolic syndrome showed significantly more psychological symptoms.
Pregnant women and premature born children were classified into four groups. In each group there were thirty of them. The first group included the pregnant women with premature rupture of membranes ...and amniotic fluid effluxed for 72 hours before the delivery. The second group included the pregnant women with amniotic fluid effluxing less then 72 hours before the delivery. The third group included the pregnant women who were given corticosteroids. The forth group was a control group formed by those pregnant women (and their premature born children) whose amniotic fluid did not efflux long and those who weren't given corticosteroids during pregnancy. In all groups of pregnant women we observed: median age of pregnant women, the duration of pregnancy and mode of delivery (vaginal or cesarean section). In groups of premature born children we also observed: newborn birth weight, Apgar score in the first minute after delivery, Apgar score in the fifth minute after delivery, pH of the blood of umbilical cord, L/S ratio of amniotic fluid (lecithin-sphingomyelin ratio), RDS (neonatologist valuation in any degree of RDS developed et newborn child). Symptoms of RDS include tachypnoea, chest wall retraction and cyanosis and a zground glass' appearance of the chest on X-ray. Histopatological examinations of placentas compared the frequency of inflammatory or noninflammatory changes, also in all groups. No significant difference was found among groups of pregnant women for the following factors: the age of pregnant women, the duration of pregnancy and mode of delivery. No significant difference was found among the groups of children for the following factors: newborn birth weight, Apgar score in the fifth minute after delivery, blood pH of umbilical cord, L/S ratio of amniotic fluid. Significant difference was found among groups for the following factors: Apgar score in the first minute after delivery, the frequency of RDS and hystology of placentas. The prevention of premature delivery is the most important. All the pregnant women with symptoms of the premature delivery must be transported to the centers with the well developed unites of intensive neonatal care ("transport in utero").
Objective: Examination and comparison of the natural histories of triplet versus quadruplet and quintuplet gestations.
Study design: A retrospective study of sixty-four multifetal pregnancies ...(fifty-two sets of triplets, nine sets of quadruplets and three sets of quintuplets) cared for during past 12 years in our department. Quintuplets and quadruplets were compared with triplet pregnancies according to gestational age, birthweight, pregnancy complications and perinatal outcome. Student’s
t-test, Fisher exact test and
χ
2 test were used for statistical analysis, considering
P value of <0.05 as statistically significant.
Results: Although mean gestational age at delivery between triplets and higher order gestations was not significantly different, birthweight of quadruplets and quintuplets was significantly lower. Pregnancy complications, including intrauterine growth retardation, were equally distributed between the groups. Early neonatal and perinatal mortality were significantly higher in quadruplets and quintuplets than in triplets. Surprisingly, survival of growth retarded fetuses was better than survival of their eutrophic counterparts. The spontaneous loss rate was 11.5% for entire triplet gestation and 16.7% for quadru- and quintuplet pregnancies.
Conclusions: As the spontaneous loss rate of triplets and higher order pregnancies observed in our study is quite similar to pregnancy loss rate caused by multifetal pregnancy reduction, conservative management of multifetal pregnancies in specialised tertiary centers seems to be a prudent solution.
Objective: To study the association between fetal blood flow abnormalities and the occurrence of long-term neurologic sequelae.
Study design: Umbilical, aortic and middle cerebral artery blood flow ...parameters were obtained by Doppler examination and retrospectively analyzed in 128 high-risk singleton pregnancies, followed by neurologic examination of the surviving children at 3 years of age. Traditional parameters of neurologic outcome (Apgar scores, intrauterine growth retardation (IUGR), umbilical artery pH and base deficit, gestational age, birth weight, newborn encephalopathy, mode of delivery, fetal heart rate, neurosonographic examination) were included as possible confounding factors. Mann–Whitney
U-test, Student’s
t-test, analysis of variance or Fisher’s exact test, where applicable, were used for the univariate analysis. A stepwise logistic regression procedure was conducted to test the independent association of selected perinatal risk factors on neurological outcome. Statistical significance was assumed at
P<0.05.
Results: Eighteen out of 114 surviving children suffered neurologic illness at 3 years of age. Four children had major neurologic dysfunction and the remaining 14 suffered minor or mild form of the disease. Although blood flow parameters and various perinatal parameters did not differ significantly between the group of children with major neurologic dysfunction and healthy children, aortic resistance index showed an independent association with occurrence of minor or mild neurologic disabilities.
Conclusion: Antenatal evaluation of the aortic blood flow might be an important predictive variable for permanent neurologic disturbances.
